Improving Outcomes of Adolescents in Residential Substance use Treatment via a Technology-Assisted Parenting Intervention

项目说明 青少年在住宅区物质使用(SU)治疗中SU障碍最严重，最高 心理、行为、法律、环境和职业问题的比率。住宅区的青少年 SU治疗也有很高的复发风险，随访研究表明，60%的出院 青少年会在90天内复发。育儿做法，包括父母监测和亲子关系 沟通，已被确定为青少年SU结果和复发可能性的关键预测因素， 但众所周知，父母很难接受青春期苏的治疗。因此，显然需要 为接受家庭SU治疗的青少年的父母提供有效、可获得和可扩展的干预措施。 基于我们成功的NIDA资助的R34，这项研究评估了一种技术辅助的育儿方式 被称为父母SMART(家庭治疗中青少年滥用物质)的干预 有高度可行性和可接受性的证据，以及有效性的初步证据，作为 像往常一样作为短期住院治疗(TAU)的补充。以现成的智能中心为中心的家长 电脑化干预，明智的育儿(PW)，已显示出改善的有力证据 在多个临床试验中提高育儿技能和减少青少年行为问题。我们进行了广泛的 与家长、青少年和住宿人员一起进行形成性研究，以指导开发和交付 两项高度可扩展的增强功能：1)访问最先进的移动网络应用程序；2)最多4个 远程健康辅导课程，以定制PW内容。我们的社交应用程序允许家长提交问题到 一位SU专家，并与其他家庭SU治疗中的青少年家长实时联系，同时 通过《每日小贴士！》强化育儿技巧推送通知。在我们的试点试验中，家长的聪明程度很高 可行和可接受的，并证明在改善父母监督和 沟通，减少青少年酗酒和使用所有其他药物的天数，减少与学校有关的时间 问题，在短期住院治疗中的父母。本R01建议对以下各项进行全面评估 聪明的家长。青少年-父母二元组(n=220个二元组，总共440个)将随机接受 仅限TAU或母公司SMART+TAU。多方法后续评估(即，自我报告家长和 青少年措施、亲子活体互动任务、8面板尿液筛查)将进行6- 出院后12周和24周，以检查父母的养育技能、青少年SU和青少年问题 行为。探索性分析将测试育儿技能的改善是否在一定程度上中介了减少 在青春期的苏。拟议的研究有可能通过以下方式推动该领域的发展：满足高需求， 在关键治疗关头服务不足的人群；针对育儿实践(假定的调解人) 已被证明可以预测青少年SU的结果；解决获得持续护理的障碍；以及 通过广泛的形成性研究，测试高度可扩展的干预模型。

Project Description Adolescents in residential substance use (SU) treatment have the most serious SU disorders and the highest rates of psychological, behavioral, legal, environmental, and vocational problems. Adolescents in residential SU treatment are also at high risk of relapse, with follow-up studies demonstrating that 60% of discharged adolescents relapse within 90 days. Parenting practices, including parental monitoring and parent-adolescent communication, have been established as key predictors of adolescent SU outcomes and likelihood of relapse, but parents are notoriously difficult to engage in adolescent SU treatment. Accordingly, there is a clear need for effective, accessible, and scalable interventions for parents of adolescents receiving residential SU treatment. Building upon our successful NIDA-funded R34, this study evaluates a technology-assisted parenting intervention called Parent SMART (Substance Misuse among Adolescents in Residential Treatment), which has evidence of high feasibility and acceptability, as well as preliminary evidence of effectiveness, as an adjunct to short-term residential treatment as usual (TAU). Parent SMART centers around an off-the-shelf computerized intervention, Parenting Wisely (PW), which has demonstrated robust evidence of improving parenting skills and reducing youth behavior problems in multiple clinical trials. We conducted extensive formative research with parents, adolescents, and residential staff to guide the development and delivery of two highly scalable enhancements: 1) access to a state-of-the-art mobile networking app; and 2) up to four telehealth coaching sessions to tailor PW content. Our networking app allows parents to submit questions to an SU expert and connect with other parents of adolescents in residential SU treatment in real-time, while reinforcing parenting skills via “Tip of the Day!” push notifications. In our pilot trial, Parent SMART was highly feasible and acceptable, and demonstrated evidence of effectiveness in improving parental monitoring and communication, reducing days of adolescent binge drinking and all other drug use, and reducing school-related problems, among parents in short-term residential treatment. This R01 proposes a fully powered evaluation of Parent SMART. Adolescent-parent dyads (n = 220 dyads; 440 in total) will be randomized to receive either TAU only or Parent SMART + TAU. Multi-method follow-up assessments (i.e., self-report parent and adolescent measures, parent-adolescent in vivo interaction task, 8-panel urine screens) will be conducted 6-, 12-, and 24-weeks post-discharge, to examine parenting skills, adolescent SU, and adolescent problem behaviors. Exploratory analyses will test whether improvements in parenting skills partially mediate reductions in adolescent SU. The proposed research has the potential to advance the field by: serving a high-need, underserved population during a vital treatment juncture; targeting parenting practices (putative mediators) that have been shown to predict adolescent SU outcomes; addressing barriers to accessing continuing care; and testing a highly scalable intervention model informed by extensive formative research.